Uterine torsion: A review with critical considerations for the obstetrician and gynecologist
Raymond Liang, Jason Gandhi, Benjamin Rahmani, Sardar Ali Khan
Abstract
Uterine torsion is a gynecologic emergency defined as the rotation of the uterus of more than 45°. It is an uncommon disorder that is termed a “once-in-a-lifetime” diagnosis for obstetricians and gynecologists. Using the search queries “uterine torsion” or “uterus” and “torsion,” a MEDLINE® database search of original research articles and case reports was piloted to obtain current information regarding the etiology, diagnosis, management, and potential complications of uterine torsion. Uterine torsion is usually found in pregnant women, carrying a degree of risk of perinatal mortality. There are several potential risk factors for uterine torsion such as leiomyoma. Diagnosis is difficult due to the rarity of the condition but must not be delayed as to prevent complications. Though there are no standard imaging criteria, CT or MRI can produce a preoperative diagnosis. Cesarean section yields the most certain diagnosis. Fortunately, there are many treatment techniques to eliminate complications, starting with laparotomy and detorsion. Despite the extreme rarity of uterine torsion, particularly in nongravid patients, a missed diagnosis can be very consequential. Obstetricians and gynecologists must have a high index of suspicion in the critical consideration for cesarean section and potential ischemia/reperfusion injury.